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Psychiatric Consultation in a Psychotropic Medication Oversight Program for Foster Children: The Illinois Model. Michael W. Naylor, M.D. University of Illinois at Chicago Director, Clinical Services in Psychopharmacology. Background. Historical context

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Psychiatric Consultation in a Psychotropic Medication Oversight Program for Foster Children: The Illinois Model

Michael W. Naylor, M.D.

University of Illinois at Chicago

Director, Clinical Services in Psychopharmacology

background
Background
  • Historical context
    • DCFS challenged by federal courts, DOJ and ACLU
      • inadequate casework
      • chaotic and dangerous placements
      • substandard care
    • Illinois violating constitutional rights of children
background1
Background
  • Historical context
    • ChicagoTribune 1995 editorial series:
      • DCFS called “the worst child welfare system in America…” and “a cruel, indifferent bureaucracy that harms kids.”
      • “system of shame”
background2
Background
  • Historical context
    • Federal court-approved consent decree (B.H. v Suter, 1991)
      • DCFS and ACLU agree to collaborate on system reform plan
state context
State Context
  • Psychotropic medication consent
    • DCFS Rule 325
    • Clinicians wishing to start a foster child on a psychotropic medication must obtain consent from the DCFS Guardian
state context1
State Context
  • DCFS Psychotropic Medication Consent Program
    • Two components:
      • Centralized Psychotropic Medication Consent Line
        • Office of the DCFS Guardian
      • Clinical Services in Psychopharmacology
        • University of Illinois at Chicago
state context2
State Context
  • Centralized Psychotropic Medication Consent Line
    • Office of the DCFS Guardian
      • legal guardian for children committed to the Department
      • responsible for providing consent for medical, surgical, and psychiatric treatment
state context3
State Context
  • Clinical Services in Psychopharmacology
    • provide independent review for all psychotropic medication requests
    • monitor utilization of psychotropic medications
    • provide consultation on particularly complicated cases
state context4
State Context
  • Clinical Services in Psychopharmacology
    • notify the Guardian where provider patterns warrant review
    • conduct training for DCFS, foster parents and childcare providers on psychotropic medications
    • disseminate information regarding new pharmaceutical developments and alerts
psychotropic medication request form
Psychotropic MedicationRequest Form
  • Demographic information
  • name
  • DCFS ID Number
  • date of birth
  • sex
  • race
  • weight and height
  • placement
  • physician’s name and specialty
psychotropic medication request form1
Psychotropic MedicationRequest Form
  • Clinical information
    • diagnosis
    • current medications and dosage
    • symptoms/rationale
    • requested medication
      • dosage and frequency
consultation
Consultation
  • Three main providers of consultation for clinicians treating foster children:
    • Clinical Services in Psychopharmacology
    • DocAssist
    • Consult for Kids
clinical services in psychopharmacology
Clinical Services in Psychopharmacology
  • Consultation
    • consent process
      • independent review of the appropriateness of the psychotropic medication consent request
      • recommend action to DCFS
        • approve
        • deny
        • modify
clinical services in psychopharmacology1
Clinical Services in Psychopharmacology
  • Consultation
    • oversight
      • formal
        • high risk prescribers
        • emergency medication utilization
      • informal
        • feedback from Administrative Case Reviews
        • concerns expressed by caseworkers, regional nurses, guardian ad litem, Court Appointed Special Advocates, judges, Office of the DCFS Guardian
clinical services in psychopharmacology2
Clinical Services in Psychopharmacology
  • Consultation
    • clinical
      • clinical concerns that arise in the course of the independent medication review
      • MD:MD
      • review of consent history
      • chart review
      • face-to-face
clinical services in psychopharmacology3
Clinical Services in Psychopharmacology
  • Consultation
    • prior authorization
      • provided consultation to HFS vis-à-vis prior authorization for antipsychotic medications and stimulants for children
      • DCFS consent for a medication serves as prior authorization for foster children
clinical services in psychopharmacology4
Clinical Services in Psychopharmacology
  • Consultation
    • systemic
      • consult on development of policies, best practice guidelines re: mental health care for foster children
      • co-write legislation
clinical services in psychopharmacology5
Clinical Services in Psychopharmacology
  • Consultation
    • monitoring/QI
      • medication utilization patterns
        • rate of copharmacy with two or more antipsychotics
        • rate of polypharmacy by age group
      • timeliness of consent process
      • compliance with Rule 325
consultation1
Consultation
  • Illinois DocAssist
    • established through the joint efforts of the Department of Healthcare and Family Services, the Department of Human Services – Mental Health, and the University of Illinois at Chicago
    • funding support by the Illinois Children’s Mental Health Partnership
consultation2
Consultation
  • Illinois DocAssist
    • clinical
      • quality of treatment for Medicaid funded children with mental illness in the primary care setting
    • client – Medicaid funded providers with a focus on primary care
    • purpose – improve the identification, diagnosis and treatment of children and youth with mental health issues through consultation, education and referral services
consultation3
Consultation
  • Consult for Kids Program
    • established by DCFS to provide primary care clinicians participating in HealthWorks with resources to evaluate foster children in their care for mental health and behavioral concerns
consultation4
Consultation
  • Consult for Kids Program
    • clinical
      • address questions and concerns about a foster child’s emotional, interpersonal, behavioral or cognitive problems
    • client – primary care providers
    • purpose – help primary care providers navigate a challenging child through the child welfare system
consultation5
Consultation
  • Challenges to effective consultation
    • “silo-ization”
      • duplication of services
      • lack of coordination
    • informing stakeholders of the services
    • meeting demand for services
consultation6
Consultation

“The Curse of Unwelcome Oversight

and Unrequested Consultation.”

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